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Introduction: Diabetic ketoacidosis is a modality of onset and a severe complication of type 1 diabetes. As younger are the pacients, as higher the onset of diabetic ketoacidosis is. Acute cerebral edema is a redoubtable complication of diabetic ketoacidosis (DKA), representing the leading cause of mortality in patients with type 1 diabetes. The etiology of cerebral edema complicating DKA is still unknown although over time there were exposed a number of hypotheses: 1) excessive amount of intravenous fluids, 2) early insulin therapy with brutal lowering blood glucose, 3) severity of acidosis at onset, 4) infectious disease associated. The clinical picture of cerebral edema is made from a combination of symptoms due to increased intracranial pressure and compression of the brain stem. Materials and Methods This paper is based on a retrospective study conducted over a period of five years, on a group of 388 patients from the Department of Diabetes and Metabolic Diseases - "MS Curie" - Hospital, diagnosed with Type 1 diabetes at onset. Of these 388 patients, 122 had diabetic inaugural ketoacidosis in various stages of severity. Acute cerebral edema (ACE) was diagnosed in 47 patients of those 122 with ketoacidosis. Diagnosis was mainly based on clinical symptoms (headache, vomiting, altered sensory, seizures), being confirmed in some cases by computer tomography. In the study were analyzed the precipitating / aggravating factors of ACE which can be: toxic factors, infectious one, severity of ketoacidosis, hydratation over measure, severe drop in blood glucose, administration in bolus of sodium bicarbonate. Treatment of acute cerebral edema targeted the administration of depleting brain substances (Manitol, Furosemide, Dexamethasone) and correction of precipitating or aggravating factors. Evolution was a favorable one, even in cases with complications that required oro-tracheal intubation at the end mortality was zero. Conclusions: Acute cerebral edema - classified in three categories: cytotoxic, vasogenic and interstitial, is an unpredictable complication of DKA. Clinical manifestations of this are the same regardless of the cause and pathogenesis. Cerebral edema remains a potentially fatal complication of DKA and therefore early diagnosis, rapid establishment and proper treatment are crucial. [ABSTRACT FROM AUTHOR]